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Legal action, diabetes, blood supply and amputations – the issues

A recent study by Diabetes UK found that in the UK 169 people a week were undergoing amputation procedures of some kind as a result of diabetes. The vast majority of these relate to unhealed ulcers and foot infections. Currently, diabetes effects 3.7 million people in the UK and there has been a steady rise in amputations linked to diabetes over the last seven years or so.

Most diabetic patients have type two diabetes which is predominantly linked to lifestyle and obesity. There are a number of diets which are being trialled which have the ability in some people to reverse diabetes and in others at least to assist with a healthier lifestyle.

Currently, it is estimated that at least £1 of every £140 spent by the NHS is spent on foot care for diabetics. Most diabetic amputations start with amputations of the toes or a foot and although these may be considered minor, they are in themselves potentially life-changing procedures.

Many of my clients are diabetic with the care that has not been adequate resulting in an amputation. Sometimes there is a general failure simply to recognise the higher risks diabetics face. It is a fact that people living with diabetes must be taught how to look after their feet and to check regularly for signs of problems. However, it is also important that the care is provided in order to assist them when a problem arises.

High blood sugar levels, which are a feature of diabetes because there is often poor control, ultimately damage blood vessels and this leads to poor circulatory supply to the feet. The services provided for diabetic patients can be somewhat of a postcode lottery and much of it has been privatised. Private companies may provide, for example, podiatry care and on occasions, there has been a failure to communicate between NHS and independent providers leading to a delay in treatment.

Legally, these cases are challenging, and it is important that if you are a diabetic and have sustained an amputation that you are aware of the difficulties. In order to establish a claim, it is necessary to demonstrate that the care was not of an appropriate standard and that the failure made a difference.

In many cases, poor care is easy to establish. The community nurses did not provide adequate care, the referral was not made quick enough or the podiatrist did not notice the ongoing difficulties or did not refer to a more specialist team at an earlier stage. These are all issues presented in cases with which I have dealt.

The second issue, however, is the difference that adequate care would have made. This is often the more difficult area in clinical negligence litigation. Many of the patients considering legal action have already had a number of minor amputations. They often have had a number of vascular procedures aimed at improving the blood flow to the feet and lower limbs. They can assume these have been successful and the blood flow is as good as ever. They can be completely without symptoms for some time.

However, the fact they have no symptoms does not mean that the blood flow is not becoming a problem again. If the diabetes isn’t controlled as well as it could be or the patient is a smoker, then problems often reoccur. It can be very difficult in those circumstances to argue that even with good care there would have been a difference. It is important for potential claimants to be aware that the more procedures they have had to improve blood flow or to deal with ulcers, the less likely they will be able to establish that the poor care is the cause of the amputation.

It is perhaps easy sometimes to assume that poor care directly led to an amputation. Legally it is not simple to connect the two, although it would seem so on the face of it. Vascular experts can be extremely reluctant to argue that better care would have made a difference to outcome and more likely to consider that the outcome was inevitable.

This is not to suggest that these cases should not be investigated but patients should be aware of the problems that arise from multiple prior procedures. Potential claimants should be aware of this when deciding to investigate a legal claim and always maintain a realistic view of the case.

Diabetes carries with it potentially significant risks. Diabetic patients should be given the appropriate care and health professionals should be conscious of the high risks associated with the condition. The figures suggest that this is not always happening. However the increase in amputations does not necessarily give rise to an increase in successful clinical negligence claims. For the claimant who has lost a limb this can be difficult to come to terms with as an amputation is a life-changing event.